Three Part Question

Clinical Scenario

A 42 year old gentleman presents to the ED with loin pain radiating to the groin. Investigations confirm the diagnosis of a small renal stone. You wonder if, instead of invasive therapy or medical expulsion, the stone can simply be “washed out” with fluid and diuretics.

Study 1: no significant difference in pain after 6 hours Study 2: No significant differences in any of the outcomes

Study 1: no report on how randomised, was not blinded.
Study 2: patients blinded but investigators were not.

Comment(s)

Theoretically, by pushing fluids or giving diuretics the renal output will increase, causing a build up of pressure behind the stone and therefore increasing the stones passage. This increased pressure could also potentially lead to rupture of the ureter and severe renal impairment. This potential danger, with no proven benefits in the literature, suggests that fluids should not be used in the clinical setting. Further large scale RCTs, particularly including diuretic management, would be beneficial.

Clinical Bottom Line

High volume fluids should or diuretics are not recommended for use in patients with renal stones